Like family

RN stands in as source of support for cardiac patient

A 77-year-old man was admitted to our hospital for intermittent chest pain, which he said was causing heavy pressure.

The patient, Mr. B., lived alone in a senior community. His wife had died a few years before and his two children lived out of state. After diagnostic testing, doctors told him he needed open heart surgery.

There are medical risks for patients and families to consider with almost any surgery. For these difficult and complex decisions, many people turn to family and close friends for support and advice. Mr. B spoke with his children by phone but preferred to discuss his surgery with them in person. He felt alone in making the decision.

Seeing Mr. B was upset that his children couldnít be with him for the surgery, I asked him whether there was anything I could do to help. He said to me, ďWhat would you do if I was your dad?Ē

Mr. Bís question immediately took me back 20 years to when my family and I helped my father make the decision to have open heart surgery. We were well aware of the risks and still chose to go ahead with the procedure. There were complications and my father died during the surgery.

It was a painful time for my family and me, but we all understood it was the worst-case scenario. Being a nurse, I understood the medical team did everything in their power to help my dad and that his case was different from Mr. Bís.

I didnít allow what happened to my father sway my answer to Mr. B, although I easily could have let it influence my care. Each person is different, even though the scenarios may be similar. Mr. B was a good candidate for open heart surgery and I suggested he carefully weigh what his doctor recommended and consider the surgery. After serious deliberation, he decided to go ahead with it.

Mr. B had a successful coronary artery bypass graft. After spending a couple of days in intensive care, he returned to our unit and I had him as my patient again.

He experienced some cardiac issues that we treated immediately. He had a rapid ventricular response and was placed on an Amiodarone drip. He also had respiratory issues, shortness of breath on exertion, a low-grade temperature and edema of his lower extremities.

In caring for him, I encouraged him to use the incentive spirometer and elevate his lower legs while sitting or supine. He also was treated with diuretics and respiratory therapy every six hours as needed.

At the end of the shift, Mr. B told me he felt relieved to have been able to speak with me about his surgery and to have me as a support person. After a few days, Mr. B was discharged with home healthcare.

Caring for Mr. B was bittersweet. It made me think about my fatherís surgery and brought back sad memories, but I was happy and relieved that the surgery went well for my patient. It was almost cathartic, being able to think about what happened to my dad and maybe even release some emotions I had been keeping inside.

Nurses naturally connect with patients who have experienced circumstances similar to ours. We become genuinely interested in their well-being and want the best for them ó just as we would for our own families. It was a joy to see my patient get better and be able to go home, even though my father didnít have the same postoperative outcome.

As with any difficult decision in or out of the hospital, we think about the advantages and the risks and make the best decision based on what we know. It helps to have caring family and caring nurses and doctors for support along the way.

Florinda Magsakay, RN-BC, BSN, PCRN, is a clinical nurse on the Special Staffing Team and a member of the Palliative Care Committee at Tampa General Hospital and has worked at the facility for almost 15 years. Send comments to editor@nurse.com or post comments below.